title: Off-pump multilayered sutureless repair for a left ventricular blowout rupture caused by myocardial infarction in the second diagonal branch territory.
abstract: A left ventricular (LV) free wall rupture is a highly lethal condition. A 78-year-old female, who collapsed while riding a bike, was admitted to our emergency service 7 days after experiencing chest pain. During admission, she had cardiopulmonary arrest. Though cardiopulmonary resuscitation was successful, computed tomography (CT) showed cardiac tamponade. Emergency surgery was then performed. Pericardiotomy revealed a postinfarction blowout rupture of an aneurysm (2 × 3 × 1 cm) on the anterolateral wall of the LV. The top of the aneurysm had a 2-mm wide blowing blood column. Intra-aortic balloon pumping was initiated. An off-pump multilayered sutureless repair using squares of collagen fleece with fibrinogen-based impregnation (i.e., TachoComb) and gelatin-resorcin-formalin glue (GRF glue) was performed. Postoperative coronary angiography revealed occlusion of the second diagonal branch. The patient was free from re-rupture or aneurysm enlargement. An LV blowout rupture, which was caused by myocardial infarction with a limited tear and necrotic area at the second diagonal branch territory, was successfully treated with an off-pump multilayered sutureless repair by using a TachoComb and GRF glue patch. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.
authors.affiliation: Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Isoda
authors.forename: Tamizo
authors.initials: T
authors.lastname: Kimura
authors.forename: Motohiko
authors.initials: M
authors.lastname: Osako
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishimura
authors.forename: Nozomu
authors.initials: N
authors.lastname: Yamanaka
authors.forename: Singo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Maehara
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007611:Aprotinin / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D002315:Cardiopulmonary Bypass; D016887:Cardiopulmonary Resuscitation; D017023:Coronary Angiography; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D005557:Formaldehyde / Q000627:therapeutic use*; D005780:Gelatin / Q000627:therapeutic use*; D006322:Heart Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006489:Hemostatic Techniques; D006801:Humans; D012118:Resorcinols / Q000627:therapeutic use*; D013536:Suture Techniques; D013917:Thrombin / Q000627:therapeutic use*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; C093991:tachocomb; D005557:Formaldehyde; D005780:Gelatin; D005340:Fibrinogen; D007611:Aprotinin; D013917:Thrombin